Impact of nutritional status on treatment completion and prognosis during adjuvant chemotherapy following gastric cancer surgery

doi:10.4240/wjgs.v18.i2.114607

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 2

This Article

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (0)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-1) series, Tables (1-10) series.

Item

Count

PDF

HTML

Figures (1-1)

Tables (1-10)

Sum=12

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=17

Publishing Process of This Article

Item

Count

Browse

Download

Sum=6

Feb 27, 2026 (publication date) through Feb 26, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Feb 27, 2026; 18(2): 114607
Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.114607

Table 1 Comparison of patient baseline characteristics, n (%)/mean ± SD

Item	Total (n = 80)	Nutritional risk group (n = 37)	Non-nutritional risk group (n = 43)	χ²/t	P value
General clinical data
Gender				0.089	0.765
Male	49 (61.2)	23 (62.2)	26 (60.5)
Female	31 (38.8)	14 (37.8)	17 (39.5)
Age (years)	62.4 ± 11.2	63.8 ± 10.9	61.2 ± 11.4	1.084	0.282
BMI (kg/m²)	22.3 ± 3.8	21.1 ± 3.4	23.3 ± 3.9	-2.765	0.007
Smoking history	34 (42.5)	17 (45.9)	17 (39.5)	0.331	0.565
Drinking history	28 (35.0)	14 (37.8)	14 (32.6)	0.237	0.626
Comorbidities
Hypertension	31 (38.8)	16 (43.2)	15 (34.9)	0.579	0.447
Diabetes	18 (22.5)	9 (24.3)	9 (20.9)	0.125	0.724
Cardiovascular disease	12 (15.0)	7 (18.9)	5 (11.6)	0.835	0.361
Tumor-related data
Tumor location				2.341	0.505
Fundus	8 (10.0)	5 (13.5)	3 (7.0)
Body	22 (27.5)	11 (29.7)	11 (25.6)
Antrum	42 (52.5)	18 (48.6)	24 (55.8)
Total stomach	8 (10.0)	3 (8.1)	5 (11.6)
Gross type				3.247	0.355
Ulcerative	45 (56.2)	22 (59.5)	23 (53.5)
Fungating	18 (22.5)	8 (21.6)	10 (23.3)
Infiltrative	14 (17.5)	5 (13.5)	9 (20.9)
Stenotic	3 (3.8)	2 (5.4)	1 (2.3)
Histological type				4.892	0.180
Well-differentiated adenocarcinoma	15 (18.8)	5 (13.5)	10 (23.3)
Moderately-differentiated adenocarcinoma	28 (35.0)	12 (32.4)	16 (37.2)
Poorly-differentiated adenocarcinoma	31 (38.7)	17 (45.9)	14 (32.6)
Signet ring cell carcinoma	6 (7.5)	3 (8.1)	3 (7.0)
T stage				3.892	0.273
T1	12 (15.0)	4 (10.8)	8 (18.6)
T2	23 (28.8)	9 (24.3)	14 (32.6)
T3	31 (38.7)	16 (43.2)	15 (34.9)
T4	14 (17.5)	8 (21.6)	6 (14.0)
N stage				4.537	0.103
N0	22 (27.5)	8 (21.6)	14 (32.6)
N1	26 (32.5)	10 (27.0)	16 (37.2)
N2	19 (23.8)	11 (29.7)	8 (18.6)
N3	13 (16.2)	8 (21.6)	5 (11.6)
TNM stage				5.847	0.054
Ib	12 (15.0)	3 (8.1)	9 (20.9)
II	35 (43.8)	14 (37.8)	21 (48.8)
III	33 (41.2)	20 (54.1)	13 (30.2)
Vascular invasion	38 (47.5)	21 (56.8)	17 (39.5)	2.379	0.123
Neural invasion	29 (36.2)	16 (43.2)	13 (30.2)	1.436	0.231
Preoperative CEA (ng/mL)	8.2 ± 15.3	10.1 ± 18.2	6.7 ± 12.1	1.015	0.313
Preoperative CA19-9 (U/mL)	42.8 ± 86.4	51.7 ± 102.3	35.2 ± 71.8	0.852	0.397
Preoperative CA72-4 (U/mL)	15.6 ± 32.4	19.8 ± 38.7	12.1 ± 26.2	1.038	0.302

BMI: Body mass index; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CA72-4: Carbohydrate antigen 72-4.

Full Size Table

Table 2 Comparison of nutritional status assessment results between groups

Nutritional assessment indicator	Nutritional risk group (n = 37)	Non-nutritional risk group (n = 43)	t/Z	P value
Baseline nutritional status
NRS2002 score (points, mean ± SD)	4.2 ± 1.1	2.1 ± 0.8	10.174	< 0.001
CONUT score [M (P25, P75)]	4 (3, 6)	2 (1, 3)	-4.832	< 0.001
PNI (mean ± SD)	42.1 ± 6.8	48.9 ± 5.2	-4.952	< 0.001
GPS score, n (%)
0 points	8 (21.6)	32 (74.4)	22.356	< 0.001
1 point	18 (48.6)	9 (20.9)
2 points	11 (29.7)	2 (4.7)
Weight loss percentage (%)	8.7 ± 4.2	3.1 ± 2.8	7.089	< 0.001
Post-chemotherapy nutritional status
NRS2002 score (points, mean ± SD)	4.8 ± 1.3	2.4 ± 0.9	9.635	< 0.001
CONUT score [M (P25, P75)]	5 (4, 7)	2 (1, 4)	-5.247	< 0.001
PNI (mean ± SD)	39.8 ± 7.1	47.6 ± 5.8	-5.401	< 0.001
Weight loss percentage (%, mean ± SD)	12.4 ± 5.1	4.8 ± 3.2	7.852	< 0.001

NRS2002: Nutritional Risk Screening 2002; CONUT: Controlling Nutritional Status; PNI: Prognostic Nutritional Index; GPS: Glasgow Prognostic Score.

Full Size Table

Table 3 Comparison of treatment completion between groups, n (%)/mean ± SD

Item	Nutritional risk group (n = 37)	Non-nutritional risk group (n = 43)	χ²/t	P value
Completed all planned cycles	28 (75.7)	41 (95.3)	6.859	0.009
RDI (%)	78.6 ± 14.2	92.1 ± 8.7	-5.142	< 0.001
RDI grouping
≥ 85%	18 (48.6)	38 (88.4)	15.671	< 0.001
< 85%	19 (51.4)	5 (11.6)
Actual completion cycle proportion
100%	28 (75.7)	41 (95.3)	8.762	0.013
80%-99%	6 (16.2)	2 (4.7)
< 80%	3 (8.1)	0 (0)
Treatment adjustment
Dose reduction	15 (40.5)	7 (16.3)	6.025	0.014
Treatment delay	18 (48.6)	9 (20.9)	6.896	0.009
Early termination	9 (24.3)	2 (4.7)	6.859	0.009

RDI: Relative dose intensity.

Full Size Table

Table 4 Logistic regression analysis of factors affecting treatment completion

Factor	Univariate analysis		Multivariate analysis
Factor	OR (95%CI)	P value	OR (95%CI)	P value
Age (≥ 65 years)	2.341 (0.896-6.118)	0.082
BMI (< 22 kg/m²)	2.156 (0.824-5.642)	0.118
NRS2002 ≥ 3 points	5.892 (1.842-18.849)	0.003	4.829 (1.542-15.114)	0.007
CONUT score ≥ 5 points	3.784 (1.369-10.464)	0.010
PNI < 45	4.125 (1.476-11.524)	0.007	3.247 (1.089-9.683)	0.035
GPS score ≥ 1 point	2.678 (0.989-7.250)	0.053
TNM stage III	3.542 (1.289-9.735)	0.014	2.894 (1.023-8.187)	0.045
Preoperative CEA (≥ 5 ng/mL)	2.134 (0.792-5.745)	0.133

BMI: Body mass index; NRS2002: Nutritional Risk Screening 2002; CONUT: Controlling Nutritional Status; PNI: Prognostic Nutritional Index; GPS: Glasgow Prognostic Score; CEA: Carcinoembryonic antigen; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Table 5 Incidence of chemotherapy adverse reactions between groups, n (%)

Adverse reaction	Nutritional risk group (n = 37)		Non-nutritional risk group (n = 43)		P value
Adverse reaction	Any grade	≥ grade 3	Any grade	≥ grade 3	P value
Hematologic toxicity
Leukopenia	32 (86.5)	16 (43.2)	31 (72.1)	8 (18.6)	0.015
Neutropenia	30 (81.1)	15 (40.5)	29 (67.4)	7 (16.3)	0.012
Thrombocytopenia	24 (64.9)	8 (21.6)	22 (51.2)	4 (9.3)	0.127
Anemia	28 (75.7)	6 (16.2)	26 (60.5)	3 (7.0)	0.201
Non-hematologic toxicity
Nausea and vomiting	34 (91.9)	12 (32.4)	36 (83.7)	6 (14.0)	0.042
Diarrhea	22 (59.5)	10 (27.0)	19 (44.2)	4 (9.3)	0.039
Mucositis	18 (48.6)	5 (13.5)	15 (34.9)	2 (4.7)	0.159
Hand-foot syndrome	25 (67.6)	7 (18.9)	24 (55.8)	4 (9.3)	0.221
Peripheral neuropathy	21 (56.8)	4 (10.8)	19 (44.2)	2 (4.7)	0.298
Hepatic dysfunction	16 (43.2)	3 (8.1)	13 (30.2)	1 (2.3)	0.242
Renal dysfunction	12 (32.4)	2 (5.4)	8 (18.6)	1 (2.3)	0.398

Full Size Table

Table 6 Comparison of survival between groups, n (%)

Survival indicator	Nutritional risk group (n = 37)	Non-nutritional risk group (n = 43)	χ²	P value
Disease progression	17 (45.9)	7 (16.3)	8.973	0.003
Local recurrence	6 (16.2)	3 (7.0)
Distant metastasis	11 (29.7)	4 (9.3)
Death	10 (27.0)	4 (9.3)	4.589	0.032
Median DFS (months, 95%CI)	Not reached	Not reached	5.573	0.018
3-year DFS rate (%)	62.1	83.7
Median OS (months, 95%CI)	Not reached	Not reached	5.234	0.023
3-year OS rate (%)	72.4	90.7

DFS: Disease-free survival; OS: Overall survival; CI: Confidence interval.

Full Size Table

Table 7 Cox regression analysis of disease-free survival factors

Factor	Univariate analysis		Multivariate analysis
Factor	HR (95%CI)	P value	HR (95%CI)	P value
NRS2002 ≥ 3 points	3.241 (1.315-7.985)	0.011	2.847 (1.124-7.214)	0.027
CONUT ≥ 5 points	2.687 (1.142-6.319)	0.024
PNI < 45	2.834 (1.189-6.754)	0.019
GPS ≥ 1 point	2.156 (0.886-5.245)	0.090
TNM stage III	4.125 (1.754-9.702)	0.001	3.162 (1.287-7.768)	0.012
Vascular invasion	2.341 (0.987-5.551)	0.053
RDI < 85%	3.156 (1.387-7.182)	0.006	2.536 (1.089-5.903)	0.031

NRS2002: Nutritional Risk Screening 2002; CONUT: Controlling Nutritional Status; PNI: Prognostic Nutritional Index; GPS: Glasgow Prognostic Score; RDI: Relative dose intensity; CI: Confidence interval; HR: Hazard ratio.

Full Size Table

Table 8 Cox regression analysis of overall survival factors

Factor	Univariate analysis		Multivariate analysis
Factor	HR (95%CI)	P value	HR (95%CI)	P value
Age ≥ 65 years	2.341 (0.756-7.254)	0.140
NRS2002 ≥ 3 points	4.267 (1.274-14.289)	0.018	3.524 (1.089-11.404)	0.036
PNI < 45	3.156 (1.024-9.724)	0.045
GPS ≥ 1 point	2.789 (0.821-9.480)	0.100
TNM stage III	5.234 (1.578-17.357)	0.007	4.267 (1.241-14.658)	0.021
Neural invasion	2.456 (0.798-7.564)	0.118
RDI < 85%	2.987 (0.975-9.156)	0.055

BMI: Body mass index; NRS2002: Nutritional Risk Screening 2002; CONUT: Controlling Nutritional Status; PNI: Prognostic Nutritional Index; GPS: Glasgow Prognostic Score; RDI: Relative dose intensity; CI: Confidence interval; HR: Hazard ratio.

Full Size Table

Table 9 Comparison of nutritional status changes before and after chemotherapy between groups

Nutritional indicator change	Nutritional risk group (n = 37)	Non-nutritional risk group (n = 43)	t/χ²	P value
NRS2002 score change (points, mean ± SD)	0.6 ± 0.8	0.3 ± 0.5	2.074	0.042
CONUT score change [M (P25, P75)]	1 (0, 2)	0 (0, 1)	-2.891	0.004
PNI change (mean ± SD)	-2.3 ± 3.1	-1.3 ± 2.4	-1.653	0.102
Weight loss percentage change (%, mean ± SD)	3.7 ± 2.8	1.7 ± 1.9	3.742	< 0.001
Nutritional status progression, n (%)	8 (21.6)	2 (4.7)	5.025	0.025

NRS2002: Nutritional Risk Screening 2002; CONUT: Controlling Nutritional Status; PNI: Prognostic Nutritional Index.

Full Size Table

Table 10 Subgroup analysis of the predictive value of nutritional risk (Nutritional Risk Screening 2002 ≥ 3) on treatment outcomes

Subgroup	n	OR/HR (95%CI)	P value	Outcome
Stratified by sex (treatment completion)
Male	49	4.215 (1.089-16.314)	0.037	OR
Female	31	5.624 (0.892-35.462)	0.066	OR
Stratified by TNM stage (treatment completion)
Stage II	47	3.542 (0.687-18.264)	0.131	OR
Stage III	33	6.127 (1.456-25.783)	0.013	OR
Stratified by TNM stage (3-year DFS)
Stage II	47	2.156 (0.542-8.573)	0.276	HR
Stage III	33	3.524 (1.124-11.047)	0.031	HR

Stage Ib and II combined as stage II for analysis. DFS: Disease-free survival; OR: Odds ratio; CI: Confidence interval; HR: Hazard ratio.

Full Size Table

Citation: Zhou K, Tu RF, Lu LH, Zhang H. Impact of nutritional status on treatment completion and prognosis during adjuvant chemotherapy following gastric cancer surgery. World J Gastrointest Surg 2026; 18(2): 114607
URL: https://www.wjgnet.com/1948-9366/full/v18/i2/114607.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i2.114607